title: Association between hospice care and psychological outcomes in Alzheimer's spousal caregivers.
abstract: BACKGROUND
  Dementia care giving can lead to increased stress, physical and psychosocial morbidity, and mortality. Anecdotal evidence suggests that hospice care provided to people with dementia and their caregivers may buffer caregivers from some of the adverse outcomes associated with family caregiving in Alzheimer's Disease (AD).
  
  
  OBJECTIVE
  This pilot study examined psychological and physical outcomes among 32 spousal caregivers of patients with AD. It was hypothesized that caregivers who utilized hospice services would demonstrate better outcomes after the death of their spouse than caregivers who did not utilize hospice.
  
  
  METHODS
  The charts of all spousal caregivers enrolled in a larger longitudinal study from 2001 to 2006 (N=120) were reviewed, and participants whose spouse had died were identified. Of these, those who received hospice care (n=10) were compared to those who did not (n=22) for various physiological and psychological measures of stress, both before and after the death of the care recipient. An Analysis of Covariance (ANCOVA), with postdeath scores as the dependent variable and pre-death scores as covariates, was used for all variables.
  
  
  RESULTS
  Significant group differences were found in postdeath depressive symptoms (HAM-D; F(1,29)=6.10, p<0.05) and anxiety symptoms (HAM-A; F(1,29)=5.71, p<0.05). Most psychological outcome variables demonstrated moderate effect sizes with a Cohen's d of>0.5 between groups.
  
  
  CONCLUSIONS
  These data suggest that hospice enrollment may ameliorate the detrimental psychological effects in caregivers who have lost a spouse with Alzheimer's Disease. Based on these pilot data, further prospective investigation is warranted.
authors.affiliation: 1 Department of Psychiatry and Psychosocial Services, San Diego Hospice and The Institute for Palliative Medicine , San Diego, California.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Irwin
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.forename: Derek
authors.initials: D
authors.lastname: Koo
authors.forename: Nathan
authors.initials: N
authors.lastname: Fairman
authors.forename: Susan K
authors.initials: SK
authors.lastname: Roepke-Buehler
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Chattillion
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000451:nursing*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D018454:Spouses / Q000523:psychology*